Impact of posterior cervical spine surgery on neck pain-related driving disability and risk factor analysis of postoperative worsening or poor improvement: A retrospective multicenter cohort study.

Abstract

Background context: Previous research has shown the positive effect of 1- and 2-level anterior cervical spine surgery on driving disability; however, the impact of posterior cervical spine surgery, which is usually performed for three or more level pathologies, remains unexplored.

Purpose: To investigate the impact of posterior cervical spine surgery on neck pain-related driving disability and identify the risk factors for poor driving outcomes.

Study design: A retrospective review of a multicenter prospective database.

Patient sample: Patients undergoing posterior cervical spine surgery for degenerative cervical myelopathy.

Outcome measures: Data were collected on patient and surgical characteristics and patient-reported outcome measurements (PROMs), including the Neck Disability Index (NDI), Numeric Rating Scale for neck/arm pain, EuroQol 5 Dimension, Japanese Orthopedic Association scores, and postoperative satisfaction.

Methods: The NDI driving subscale (0-5) was used to evaluate neck pain-related driving disability at baseline and 24 months postoperatively. Driving severity was categorized as "non-to-mild" (score 0, 1, or 2) and "moderate-to-severe" (score 3, 4, or 5) and used to determine whether patients experienced postoperative improvement, worsening, or rest. Multivariate analysis was performed to identify clinical and surgical risk factors for deteriorating or persistent driving disability. We analyzed the association between driving outcomes and PROMs.

Results: Of the 1067 patients included, 277 (26.0%) reported moderate-to-severe driving disability at baseline. At 24 months, 70.8% of these patients experienced substantial improvement, whereas 29.2% did not. Among the 790 patients with baseline non-to-mild driving disability, 69 (8.7%) experienced significant postoperative deterioration. Multivariate analysis identified older age (odds ratio [OR] 2.6), female sex (OR 2.2), and ≥4-level fusion (OR 2.4) as significant risk factors for postoperative worsening, whereas older age (OR 2.1) was the significant risk factor for poor postoperative improvement. Patients with poor outcomes were less likely to achieve clinically significant improvements in all PROMs.

Conclusions: Posterior cervical spine surgery can improve driving disability associated with neck pain. Nevertheless, the potential risk of postoperative deterioration or poor improvement should be considered, particularly among patients who are older, female, or have undergone ≥4-level fusion surgery.